Generalized Anxiety Disorder(GAD): From Overwhelm to Overcome

Have you ever felt that you always worry about anything and everything? Do you find yourself always waiting for something bad to happen? If you answered yes to both questions, you might be suffering from a type of anxiety disorder called Generalized Anxiety Disorder(GAD).

Background on anxiety

Anxiety refers to the general feeling of apprehension about possible future danger. At the cognitive/subjective level, anxiety manifests in the form of a negative mood, constant worry about possible future threats/dangers, self-preoccupation, and a sense of being unable to predict future threats or control them if they occur. Also the physiological level, anxiety manifests as a state of tension, chronic over-arousal, and flight/fight response activation. At the behavioural level, anxiety manifests in the form of avoidance of any situation that feels potentially dangerous.

Read More: Anticipatory Anxiety: Meaning, Symptoms and How to cope

Generalized Anxiety Disorder

Anxiety disorders typically involve unrealistic, irrational fears or anxieties that disable individuals and interfere with their daily lives and functioning. Generalized Anxiety Disorder(GAD) manifests as excessive “free-floating” anxiety under most circumstances, wherein the individual diagnosed with GAD worries about practically anything. DSM-5 states that for a diagnosis of GAD, the individual should have experienced the following symptoms for at least 6 months:

1. Difficulty in containing or controlling the worry and anxiety
2. Excessive or constant anxiety and worry about a variety of events and activities
3. At least three of these symptoms are experienced and cause significant distress or impairment:
   • Irritability
   • Easily fatigued
   • Muscle tension
   • Sleep disturbances
   • Feeling restless or on edge
   • Face difficulty in concentrating

(As a general note of caution, if you feel that you have been experiencing these symptoms, please reach out to a certified clinical psychologist to receive the diagnosis.)

Underlying causes of Generalized Anxiety Disorder

Various neurological, psychological, and social factors cause GAD, along with the feedback loops among them. To develop GAD, a person probably must experience three factors:

• Undergoing a highly stressful event or set of events such as a death in the family
• Learning certain kinds of worry-related behaviours (for example, hypervigilance for threats)
• Abnormal neurological functioning (which may reflect abnormal levels of GABA or another neurotransmitter such as serotonin and/or norepinephrine)

Any one of these alone – and probably any two of these – will not cause GAD. All three factors should occur at some level for the individual to experience GAD.

Psychodynamic view about causes of GAD

According to Sigmund Freud, all children go through some form of anxiety, which they manage through ego-defence mechanisms. However, Freud categorized this anxiety experienced by children into three types:

• Realistic anxiety: Children experience this type of anxiety when they face actual situations of danger.
• Moral anxiety: Children experience this type of anxiety when their expression of id impulses is threatened or punished.
• Neurotic anxiety: Children experience this type of anxiety when they are repeatedly prevented from expressing their id impulses, either by their parents or due to circumstances.

Freud also states that some children experience high levels of such anxiety or show inadequate defence mechanisms, eventually causing GAD. Furthermore, the psychodynamic view also suggests that unresolved childhood neurotic or moral anxiety sets the stage for generalized anxiety disorder.

Treating Generalized Anxiety Disorder

In treating Generalized Anxiety Disorder (GAD), practitioners use a combination of biological and psychosocial interventions. To deal with the underlying biological and neurological causes of GAD, medications such as anti-depressants such as SSRI or SNRI-related drugs, or anti-anxiety drugs such as benzodiazepines are prescribed. Another effective drug in treating GAD is buspirone. There is a huge role of psychological factors in causing GAD. These factors particularly influence three modes of thought and behaviour:

• Feeling that their tendency to worry is out of their control
• Hypervigilance, or being excessively alert for possible environmental threats
• Feeling that their tendency to worry helps them prevent panicking, and is, therefore, negatively reinforcing.

Read More: Cognitive Behavioral Therapy Techniques for Anxiety

Cognitive therapy methods are used to deal with these factors. This approach first psycho-educates the individuals about their condition and then goes on to train them and equip them with regulatory techniques such as meditation, self-monitoring, problem-solving and cognitive restructuring. Cognitive Behavioural Therapy involves the underlying techniques of Cognitive Therapy but also includes behavioural techniques such as biofeedback and relaxation training.

Rational Emotive Therapy is a type of Cognitive Therapy that is also used to help clients change the maladaptive assumptions underlying GAD. In this technique, therapists highlight the irrational assumptions held by clients, suggest more appropriate assumptions, and assign homework that helps in practising the skills in challenging old assumptions and applying new ones.

Another type of Cognitive Therapy called Mindfulness-based Cognitive Therapy (MBCT) is based on a broader therapeutic approach called Acceptance and Commitment Therapy. In this therapeutic approach, the therapists help clients to become aware of their streams of thoughts, including their worries, as they are occurring and to accept such thoughts as mere events of the mind. It is expected that the clients would feel less distressed and affected by their thoughts if they choose to accept them instead of trying to reject or eliminate them.

To deal with the psychodynamic causes, psychodynamic therapists use techniques such as free association and the therapist’s interpretations of transference, resistance, and dreams. Freudian psychodynamic therapists employ these techniques to assist their patients with GAD in managing their id impulses. Other psychodynamic therapists also look at relationship issues from childhood and assist in resolving those issues that recur as anxiety in adulthood.

Read More: Health Psychology’s Evolution: The Biopsychosocial Model

In conclusion, Generalized Anxiety Disorder(GAD) is a disorder characterized by excessive worry about a variety of topics and is caused by and treated using biopsychosocial mechanisms. If you feel that you or someone you know might be experiencing this disorder, please reach out to a certified clinical psychologist to receive immediate help and support.